• J Clin Anesth · Aug 2016

    Development of effective prophylaxis against intraoperative carcinoid crisis.

    • Eugene A Woltering, Anne E Wright, Melissa A Stevens, Yi-Zarn Wang, John P Boudreaux, Gregg Mamikunian, James M Riopelle, and Alan D Kaye.
    • Department of Surgery, Louisiana State University Health Sciences Center, 1542 Tulane Ave, 7th Floor, New Orleans, LA 70112, USA. Electronic address: ewolte@lsuhsc.edu.
    • J Clin Anesth. 2016 Aug 1; 32: 189-93.

    Study ObjectiveThe prophylactic use of a preoperative, intraoperative, and postoperative high-dose continuous octreotide acetate infusion was evaluated for its ability to minimize the incidence of carcinoid crises during neuroendocrine tumor (NET) cytoreductive surgeries.DesignA retrospective study was approved by the institutional review boards at Ochsner Medical Center-Kenner and Louisiana State University Health Sciences Center.SettingOchsner Medical Center-Kenner operating room and multispecialty NET clinic.PatientsOne hundred fifty consecutive patients who underwent a total of 179 cytoreductive surgeries for stage IV, small bowel NETs.InterventionsAll patients received a 500-μg/h infusion of octreotide acetate preoperatively, intraoperatively, and postoperatively.MeasurementsAnesthesia and surgical records were reviewed. Carcinoid crisis was defined as a systolic blood pressure of less than 80mm Hg for greater than 10minutes. Patients who experienced intraoperative hypertension or hypotension, profound tachycardia, or a "crisis" according to the operative note were also reviewed.Main ResultsOne hundred sixty-nine (169/179; 94%) patients had normal anesthesia courses. The medical records of 10 patients were further investigated for a potential intraoperative crisis using the aforementioned criteria. Upon review, 6 patients were determined to have had a crisis. The final incidence of intraoperative crisis was 3.4% (6/179).ConclusionsA continuous high-dose infusion of octreotide acetate intraoperatively minimizes the incidence of carcinoid crisis. We believe that the low cost and excellent safety profile of octreotide warrant the use of this therapy during extensive surgical procedures for midgut and foregut NETs.Copyright © 2016 Elsevier Inc. All rights reserved.

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